Sulpiride addition for the treatment of clozapine-induced hypersalivation: preliminary study. (9/55)

BACKGROUND: Hypersalivation is a common, troublesome side effect of clozapine treatment. It occurs in 31-54% of clozapine treated patients. Management of this stigmatizing side effect may reduce noncompliance. Reports in the literature have shown beneficial clinical effects of combined clozapine-sulpiride therapy as measured by the Brief Psychiatric Rating Scale, and we found that this treatment combination also has very strong antisalivatory activity for clozapine-induced hypersalivation. METHODS: 18 patients (12 female, 6 male) with clozapine-induced hypersalivation received sulpiride (150-300 mg/day) in addition to ongoing clozapine treatment (from 100 mg/d to 800 mg/d). Baseline, 7 day and 21 day follow-up values were recorded for the 5-point Nocturnal Hypersalivation Rating Scale. RESULTS: At the end of the trial only 3 patients complained of minimal sialorrhea, and the mean Nocturnal Hypersalivation Rating Scale scale values showed a significant reduction in sialorrhea (delta baseline-endpoint -.2.78 +/- 0.87). CONCLUSIONS: Our findings support reports of the beneficial effect of clozapine-sulpiride combination therapy and suggest that sulpiride addition may contribute to the amelioration of clozapine-induced hypersalivation.  (+info)

Respiratory distress secondary to esophageal foreign body: a case report. (10/55)

The ingestion or aspiration of a foreign body is a common, but preventable occurrence in childhood. Primary healthcare personnel should alert parents to the risk of swallowing a foreign object, the signs and the need for immediate medical attention. It should be emphasized that protecting children from access to objects that can be swallowed or aspirated is the best preventive measure. A case of an eight year old child, who had swallowed a marble ball is presented and the symptoms and intervention discussed. Medical staff should be aware of the symptomatic variation in ingested foreign body presentation and the importance of rapid diagnosis and management.  (+info)

Is atropine needed with ketamine sedation? A prospective, randomised, double blind study. (11/55)

OBJECTIVE: To compare atropine with placebo as an adjunct to ketamine sedation in children undergoing minor painful procedures. Outcome measures included hypersalivation, side effect profile, parental/patient satisfaction, and procedural success rate. METHODS: Children aged between 1 and 16 years of age requiring ketamine procedural sedation in a tertiary emergency department were randomised to receive 0.01 mg/kg of atropine or placebo. All received 4 mg/kg of intramuscular ketamine. Tolerance and sedation scores were recorded throughout the procedure. Side effects were recorded from the start of sedation until discharge. Parental and patient satisfaction scores were obtained at discharge and three to five days after the procedure, with the opportunity to report side effects encountered at home. RESULTS: A total of 83 patients aged 13 months to 14.5 years (median age 3.4 years) were enrolled over a 16 month period. Hypersalivation occurred in 11.4% of patients given atropine compared with 30.8% given placebo (odds ratio (OR) 0.29, 95% confidence interval (CI) 0.09 to 0.91). A transient rash was observed in 22.7% of the atropine group compared with 5.1% of the placebo group (OR 5.44, 95% CI 1.11 to 26.6). Vomiting during recovery occurred in 9.1% of atropine patients compared with 25.6% of placebo patients (OR 0.29, 95% CI 0.09 to 1.02). There was a trend towards better tolerance in the placebo group. No patient experienced serious side effects. CONCLUSION: Ketamine sedation was successful and well tolerated in all cases. The use of atropine as an adjunct for intramuscular ketamine sedation in children significantly reduces hypersalivation and may lower the incidence of post-procedural vomiting. Atropine is associated with a higher incidence of a transient rash. No serious adverse events were noted.  (+info)

Application of botulinum toxin to reduce the saliva in patients with amyotrophic lateral sclerosis. (12/55)

AIM: To demonstrate the effect of local application of Botox(R) in patients with amyotrophic lateral sclerosis (ALS), following our 2002 institutional protocol of sialorrhea treatment. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Five patients with ALS assisted at Clinic of Otolaryngology of AACD (Associacao de Assistencia a Crianca Deficiente). They were all submitted to local application of Botox in salivary glands and followed up for a year. The protocol consisted of clinical questionnaire about the inability of swallowing saliva and its repercussions in quality of life. Patients were submitted to previous odontological treatment, had intolerance to the adverse effects of anti-cholinergic agents and had not used Botox for at least six months. The application was guided by ultrasound and the doses were 30U in one point for submandibular gland, and 20U in two points for each parotid gland, after topic anesthetic with prilocaine. RESULTS: Five patients with ALS with sialorrhea, aged 45 to 59 years, were submitted to Botox salivary glands application. We observed that the symptoms of sialorrhea changed dramatically in four patients. Three patients stayed almost four months without complaints with repercussion in quality of life. No patient presented local or systemic effects with local injection of Botox.  (+info)

The role of saliva in maintaining oral health and as an aid to diagnosis. (13/55)

Saliva is a complex secretion. 93% by volume is secreted by the major salivary glands and the remaining 7% by the minor glands. 99% of saliva is water and the other 1% is composed of organic and inorganic molecules. While the quantity of saliva is important, so is its quality. The components of saliva, its functions in maintaining oral health and the main factors that cause alterations in salivary secretion will be reviewed, the importance of saliva in caries development and bacterial plaque formation will be discussed and its role as an aid to diagnosing certain pathologies will be examined. Variations in salivary flow can be affected, reversibly or irreversibly, by numerous physiological and pathological factors. Saliva plays an essential role in maintaining the integrity of the oral structures, in personal relationships, in the digestion and in controlling oral infection. The part that saliva plays in protecting teeth from caries can be summarised under four aspects: diluting and eliminating sugars and other substances, buffer capacity, balancing demineralisation/remineralisation and antimicrobial action. Saliva is a promising option for diagnosing certain disorders and monitoring the evolution of certain pathologies or the dosage of medicines or drugs. Its advantages as a diagnostic tool include its being easy to obtain and the positive correlation between many parameters in serum and saliva.  (+info)

Botulinum toxin type A treatment for Parkinsonian patients with moderate to severe sialorrhea. (14/55)

PURPOSE: To investigate the effect of botulinum toxin type A (BTX-A; Botox) in reducing saliva in patients with Parkinsonism. METHODS: Fifteen patients with clinical diagnosis of idiopathic Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy were enrolled in this open clinical trial. A total of 40-unit dose of Botox was injected into the bilateral parotid and submandibular glands. Objective measuring of saliva production with dental rods, subjective Drooling Score, personal impression of clinical improvement, and the duration of response were used for the global assessment of sialorrhea after BTX-A treatment. RESULTS: All patients showed objective reduction in saliva production following BTX-A treatment and the mean production was reduced at a significant level. The severity of sialorrhea assessed by Drooling Score was 5.87 +/- 0.92 (range: 5-8) and 3.60 +/- 1.18 (range: 2-6) respectively (p<0.001) before and after BTX-A injection. The mean duration of BTX-A response extended for 16.3 +/- 5.7 weeks (range: 5-24). No severe adverse effect nor worsening of existing dysphagia was observed in all Parkinsonian patients. CONCLUSIONS: Parkinsonian drooling may undermine patient's health and daily activity. BTX-A local injection is a safe and effective measure in counteracting sialorrhea, even in patients associated with moderate dysphagia.  (+info)

Manifestations of gastro-pharyngo-laryngeal reflux disease. (15/55)

In the last few years, gastro-oesophageal reflux disease has received renewed interest from the ENT specialists. The symptomatology can vary on account of the differences between the gastro-oesophageal reflux and the laryngo-pharyngeal reflux as far as concerns both symptomatology and clinical-pathogenic aspects. The symptoms and the clinical laryngoscopic aspects are discussed.  (+info)

Relationship between patients' perceptions of postsurgical sequelae and altered sensations after bilateral sagittal split osteotomy. (16/55)

PURPOSE: Following orthognathic surgery, patients use qualitatively different words to describe altered sensation on their face. These words indicate normal, hypoesthetic, paresthetic, or dysesthetic sensations and so reflect the intrusiveness of the altered sensation. The objective of this study was to examine the relationship between the intrusiveness of the altered sensation and the extent to which it and the associated impairment in facial function were perceived to be a problem in the lives of the patients. PATIENTS AND METHODS: One hundred forty-six patients who had a mandibular osteotomy with or without a maxillary procedure were included. Word choice data were obtained during patients' assessment of spontaneous and evoked facial sensations before surgery and at 1 week, 1, 3, and 6 months after surgery and the difficulty or problem levels associated with the altered sensation itself (PAS) and facial functions or oral behaviors in every day life (PAF) were obtained from validated questionnaires. Stratified-by-subject repeated measures Mantel Haenszel correlation statistics were calculated to assess the associations between the intrusiveness of the altered sensation and the problem levels associated with the altered sensation and with the facial functions. RESULTS: On average, the perception of the difficulty with each of the PAS and PAF items decreased from 1 week to 6 months after surgery (all P values < .0001). Patients reported more difficulty in every day life related to the effect of the altered sensations than they did related to the effect on facial functions. The correlations of the intrusiveness of the altered sensation and problems with altered sensations (PAS) were stronger overall and at each visit than the correlations with problems of altered facial function (PAF). Although the correlation coefficients tended to increase in value from 1 week to 6 months postsurgery for the PAF items, the increase was proportionately greater for the PAS items. CONCLUSIONS: The difficulties in everyday life perceived by patients following orthognathic surgery caused by altered sensations and, to a lesser extent, altered facial function are positively related to the type of altered sensation experienced. The extent of the difficulty follows the intrusiveness level: patients whose sensations are uncomfortable or painful report the most difficulty followed by those who experience nonpainful sensations that are not normally present (ie, positive symptoms), then those who experience only a simple loss in sensation (ie, negative symptoms). Subjective difficulty with altered sensation reflects, in part, its qualitative nature; whereas subjective difficulty with function may reflect the extent of loss in sensory innervation.  (+info)